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Cardiology > Antihypertensives > Flashcards

Antihypertensives Flashcards

1
Q

How do diuretics decrease BP?

A

Cause diuresis which reduces plasma and stroke volume causing a decrease in cardiac output and blood pressure. Most common adverse effect is hypokalemia

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2
Q

Describe the use of hydrocholorthiazide (HCTZ) as a antihypertensive agent

A

First line diuretic. Inhibits NaCl reabsorption in the distal convoluted tubule of the nephron. Patients allergic to sulfa may be allergic to HCTZ. Ineffective if creatinine >2.5

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3
Q

Describe the use of loop diuretics as antihypertensive agents

A

Selectively inhibit NaCl reabsorption in the thick ascending limb of the loop of Henle. Stronger incidence of hypokalemia. Reserve for patients with chronic renal insufficiency

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4
Q

Name the four loop diuretics

A

Furosemide (Lasix). Torsemide (Demedex). Bumetanide (Bumex). Metolazone (Zaroxolyn)

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5
Q

Describe the use of K+ sparing diuretics

A

Antagonize the effects of aldosterone at the late distal and cortical collecting tubule in the nephron. Weak when used alone, but spare K+ and Magnesium loss

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6
Q

Name the three K+ sparing diuretics

A

Aldactone (Spironolactone).Midamor (Amiloride). Dyrenium (Triamterene)

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7
Q

How do beta blockers reduce BP?

A

Reduce heart rate and Cardiac Output (Antagonize the effect of catecholamine’s at adrenoceptors.
Decrease sympathetic drive). Decrease renin release. Are cardioprotective

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8
Q

Define cardioprotective

A

Negative inotropic effect (decrease 02 consumption by the heart by decreasing the force of the contraction). Negative chronotropic effect (decrease heart rate)

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9
Q

Name the four B1 selective beta blockers

A

Metopropol (Lopressor, Toprol XL). Atenolol (Tenormin). Bisopropol (Zebeta). Acebutolol (Sectrol)

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10
Q

Name the four nonselective beta blockers

A

Propanolol (Inderal). Sotalol (Betapace). Timolol (Blocadren)

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11
Q

Name the two combination Beta and alpha 1 blockers

A

Carvedilol (Coreg). Labetolol (Trandate)

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12
Q

What are adverse effects to beta blockers?

A

Bradycardia, Heart Failure, Bronchospasm (use B1 selective for asthmatics), mask hypoglycemia, lower HDLs, hypotension

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13
Q

What are side effects of beta blockers?

A

Impotence, Depression, Sedation, Fatigue, Reduced ability to exercise, Cold extremities

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14
Q

How does hypoglycemia occur with use of beta blockers?

A

β2 adrenoceptors normally stimulate hepatic glycogen breakdown (glycogenolysis) and pancreatic release of glucagon to increase plasma glucose. blocking β2-adrenoceptors lowers plasma glucose. beta blockers mask the typical sympathetic responses to hypoglycemia…..tachycardia and tremors

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15
Q

What drugs interact with beta blockers?

A

NSAIDS-blunt effect of beta blockers. Epinephrine-causes severe hypertension in presence of beta-blockade. Calcium channel blockers: Conduction effects on heart are additive with beta blockers

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16
Q

How do ACE inhibitors lower BP?

A

Block the conversion of angiotensin I to angiotensin II, leading to artery and vein dilatation reducing arterial pressure, preload and afterload

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17
Q

How are ACE inhibitors renal and cardioprotective?

A

decrease proteinuria and chronic renal failure in diabetics. Inhibits cardiac and vascular remodeling associated with chronic hypertension, heart failure and MI

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18
Q

Name the six ACE inhibitors

A

Captopril (Capoten). Lisinopril (Zestril). Enalapril (Vasotec). Benazpril (Lotensin). Ramipril (Altace). Quinapril (Accupril)

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19
Q

For what disease conditions are ACE inhibitors considered to be the first drug of choice to treat HTN?

A

DM, CHF, chronic kidney failure, MI that causes systolic dysfunction

20
Q

What are contraindications to ACE inhibitors?

A

bilateral Renal Artery Stenosis, Should not be given with K+ sparing diuretics, pregnancy

21
Q

Describe angiotensin receptor blockers as antihypertensives

A

Blockade angiotensin II receptors. Cardioprotective and renal protective. Side effect profile similar to ACE except decreased incidence of cough. CI in pregnancy and renal stenosis

22
Q

Name the five ARBs

A

Irbesartan (Avapro). Candesartan (Atacand). Losartan (Cozaar). Valsartan (Diovan). Olmesartan Medoxomil (Benicar)

23
Q

How do calcium channel blockers reduce BP?

A

Dilate peripheral arterioles by blocking the influx of calcium into arterial smooth muscle cells. This reduces PVR and BP. Decreases contractile force and myocardial O2 requirements.

24
Q

Name the six dihyropyridines

A

Amlodipine (Norvasc), Felodipine (Plendil), Nicardipine (Cardene), Nifedipine (Procardia), Isradipine (Dynacirc), Nimodipine (Nimotop)

25
Q

What are the adverse effects of dihyropyridines?

A

reflex tachycardia, flushing, headache, excessive hypotension, edema

26
Q

What are the two non-dihyropyridines?

A

Verapamil (Calan, Isoptin) and Diltiazem (Cardizem). Also used to treat dysrhythmias, angina, headaches

27
Q

What are the adverse effects of non-dihyropyridines?

A

excessive bradycardia, impaired electrical conduction (atrioventricular nodal block), depressed contractility, concern with beta blockers, Shouldn’t be given with heart block and systolic failure.

28
Q

How do alpha 1 blockers reduce BP?

A

Block alpha receptors in small arterioles and venules. Reduce arterial pressure by dilation. Lower PVR

29
Q

For what patient populations are alpha 1 blockers reserved for?

A

Use in low doses should be reserved for unique cases such as men with BPH as data does not suggest protection against cardiovascular events.

30
Q

Name the three alpha 1 blockers

A

Prazosin (Minipress), Terazosin (Hytrin), Doxazosin (Cardura)

31
Q

How do alpha 2 receptor agonists lower BP?

A

has specificity towards the presynaptic alpha 2 receptors in the vasomotor center in the CNS.
Decrease in sympathetic outflow from the vasomotor center = decreased vasoconstriction

32
Q

What are the two alpha 2 receptor agonist and their uses?

A

Clonidine (Catapres): useful as a second or third line drug choice for lowering blood pressure when other anti-hypertensive medications have failed.
Methyldopa (Aldomet): Frequently used in pregnancy

33
Q

How are vasodilators used as antihypertensive agents?

A

Cause direct arteriolar smooth muscle relaxation by increasing cGMP. Compensatory action over time causes increased heart rate, cardiac output, renin release. Therefore, hypotensive effect diminishes unless also taking sympathetic inhibitor (beta blocker) and diuretic

34
Q

Name the three vasodilators

A

Hydralazine, Minoxidil, Reserpine

35
Q

Describe use of nitroglycerin

A

Venous and arterial dilator (in large doses). Tolerance develops when used over 24-48 hours. Used in patient with suspected or confirmed MI

36
Q

Describe use of fenoldopam

A

Short acting dopamine agonist, onset 5 mins. Increase renal blood flow, natriuresis, diuresis. Useful in renal failure patients

37
Q

Describe use of labetalol

A

Combination nonselective alpha/beta blocker, onset 2-5 minutes. Can cause orthostatic hypotension

38
Q

Describe use of hydralazine

A

Arteriolar vasodilator, onset 10-30 mins., duration 2-4 hours

39
Q

What combinations of hypertensive drugs should you avoid?

A

Beta blocker and Diltiazem (Cardizem) or Verapamil. ACE inhibitors/ARBs/K+ sparing diuretics. Clonidine and beta blockers

40
Q

What is optimal pharmacological tx for African Americans?

A

Thiazide and Calcium channel blockers

41
Q

What is the treatment of choice for patients with CAD?

A

Beta-Blockers

42
Q

What are the best treatment options for patients with left ventricular systolic dysfunction or heart failure?

A

Diuretics, ACE inhibitors, Beta Blockers (watch out for increased CHF), No Calcium Channel Blockers

43
Q

What is the best treatment option for diabetics with nephropathy?

A

ACE Inhibitors and ARBs

44
Q

What is the best treatment for patients with renal insufficiency or chronic renal failure?

A

ACE Inhibitors and ARBs

45
Q

What beta blockers can be used with heart failure?

A

Carvedilol, Metoprolol, and Bisoprolol

Cardiology (19 decks)

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